Tracy McCallin, M.D., F.A.A.P, Emergency Physician, The Children’s Hospital of San Antonio
Did you know
drowning is the second highest cause of death for children under 14 years of
age, and is the leading cause of death from preventable injury in children
between 1-4 years? As a pediatrician working in the pediatric emergency
department for the past eight years, I treat victims of drowning every year.
Seeing even one child who has drowned is one too many. Every drowning is a
preventable tragedy, and as a co-author for the recent American Academy of
Pediatrics (AAP) policy statement “Prevention of Drowning,” I am spreading the
word on water safety to give parents the knowledge they need to keep children
safe around water.
Another fact you may not know is that toddlers are at highest
risk of drowning during non-swim times. The biggest risk to these young
children is unexpected access to water, including swimming pools, hot tubs and
spas, bathtubs, toilets, and natural bodies of water. The Consumer Product
Safety Commission (CPSC) reports 69 percent of children under 5 were not
expected to be at or in the pool at the time of a drowning incident.
Developmentally, toddlers and preschoolers are curious and lack the awareness
of the dangers of water. Drowning is quiet and can take less than a minute. By
the time a parent realizes the child has slipped away and fell into a backyard
pool, pond or other body of water, it is often too late.
Physical barriers must be in place to prevent unintended access
of children to water during non-swim times. Based on the most current evidence,
installing four-sided fencing (at least 4 feet high) with self-closing and
self-latching gates that completely separates the pool from the house and yard
is the most effective way to prevent drowning in young children, preventing
more than half of swimming-pool drownings in this age group. These safeguards are vitally
important in preventing access to the water when a parent is distracted by
other children, making dinner or answering the phone.
The AAP also recommends doing a “walk through” whenever you take
your child to a new environment such as a friend or neighbor’s home or a
vacation rental, to check for bodies of water and what barriers may or may not be
in place to protect your child.
Close, constant, and attentive supervision is a critical layer
of protection against drowning when children are expected to be around the
water. Adults should provide “touch supervision”
within arm’s reach of all children in or near the water by designating a
“water watcher” who will take on this task. The watcher needs to be free from
distraction including talking on the cell phone, social media and alcohol use. For infants and
children up to age 6 years, always
supervise when bathing and never leave a younger child in the care of an older child. Remember that children
can drown in less than one minute in two inches of water or less; the time it
takes for a parent to answer the door, check on dinner or get a towel. Parents should
also know that teenagers are the group at second highest risk of drowning, and
should be counseled about alcohol use around the water and life jacket use when
boating.
Another strategy that may decrease drowning risk, which is now
recommended by the AAP, is swim lessons
beginning at 1 year of age. The decision of when to start swim lessons
must be personalized for each child, considering your child’s comfort in the water,
overall health status, developmental stage, emotional maturity, and physical
ability. The AAP policy statement recommends infants younger than 1 year are
developmentally unable to learn the complex movements, such as breathing, needed
to swim. While they may show reflexive swimming movement under water, they
cannot lift their heads well enough to breathe and there is no current evidence
to suggest a benefit of infant swimming programs under 1 year of age.
Other ways to prevent drowning include wearing U.S. Coast Guard approved life jackets when
boating and for non-swimmers or young children when in or near water. The AAP
advises everyone should have CPR
training and learn basic swimming skills, as well as swimming at sites
with lifeguards especially for
open water recreation.
There
has been much fear, confusion and misinformation in the media during recent
years about something called ‘’dry drowning” or “secondary drowning.” One of
my jobs as a pediatrician doing drowning prevention work is to help worried
families understand what drowning is and what it is not. Although you have
likely read some scary stories out there, let me reassure you there is no such thing as dry drowning or
secondary drowning. These are not actual medical conditions and the AAP
recommends using the terms “nonfatal drowning” to describe a child who did not
die from a drowning event, and “fatal drowning” to describe a death from
drowning.
Current
evidence has shown children with a drowning event will have symptoms such as
trouble breathing or lethargy within one to two hours of the event. Drowning
does not occur at a later time in children who had previously looked well.
Incidents where a “dry drowning” death was reported in the media were most
likely a coincidental event later thought to be related to water exposure days
or a week before. If your child has no problems one to two hours after
coughing, sputtering or swallowing water, you can feel reassured they will not develop
symptoms of a drowning event at a later time.
So
when do you need to worry if your child has drowned? Based on American Heart Association
(AHA) recommendations, if your child needed any type of rescue breathing or CPR
at the scene of a drowning event, they should always be taken to the emergency
department (ED) for evaluation. If your child is having trouble breathing or
other serious problems after a drowning, he or she will need to stay in the
hospital for specialized care and treatment. However, if your child is looking
well with normal vital signs and exam after observation in the ED, he or she can
be safely sent home and will not suffer a drowning related death days or a week
later.
The
best way to keep your child safe around the water is to remember there is no single
way to “drown-proof”
a child, and multiple layers of protection must be used against drowning. You
now have the knowledge you need to keep your child and other important children
in your life safe, so please share this information with others.
For
more information on drowning prevention, please visit the AAP Drowning
Prevention Campaign toolkit at https://www.aap.org/en-us/about-the-aap/aap-press-room/campaigns/drowning-prevention/Pages/default.aspx
Also,
you can visit the AAP site for parent education at https://www.healthychildren.org
to read helpful articles on water safety such as:
The Children's Hospital of San Antonio Blog 